I'm Distinguished University Professor of Economics at Gordon Ford College of Business at WKU. I've published 6 books including From The Ballfield to the Boardroom (2006) and The NCAA (1992) along with many academic articles. One of special note is a 2002 study with Robert McCormick and Bob Tollison of Clemson that looks at the racial integration of MLB and the ACC as a type of innovation. I'm supported by an incredible wife, two great daughters, and two not-so-smart but lovable Labs.

MLB's "Tommy John" Surgery -- The New Steroid Injection?

Injuries to MLB pitchers have reached epidemic levels. By some data, one-third of MBL pitchers have undergone the “Tommy John” (elbow) surgery. Uncovering the root cause(s) of this epidemic is incredibly difficult and not all that dissimilar to the difficulty in determining factors contributing to complex economic outcomes like recessions and financial crashes.

In looking over studies from sports medicine available on Pubmed searches (such as 1, 2, and 3) along with sabermetric studies (see baseballheatmaps) and columns by or interviews with leading professionals and analysts (such as NY Times, SI, Boston Globe), the current state of knowledge is unsettled:

1. Pitch counts probably matter at developmental ages with much more uncertainty at the MLB level. Even at the youth level, the evidence is not all one-sided. Ironically, Rinku Singh, one of the Indian-born pitchers featured in “Million Dollar Arm” underwent Tommy John surgery. While his is just a single case, it suggests that youth baseball isn’t the sole contributor. At the big league level, pitch counts, at least without some other influence like velocity interacting, are not very compelling. More than a decade ago, concern about MLB pitch counts drove a near-maniacal focus on limiting them but the surgery trend continues and increases. Ironically, prior to 1980, MLB leaders in innings pitched passed 300 innings. Gaylord Perry threw over 250 innings in twelve seasons – a level no MLB pitcher reached in 2012 or 2013.

2. Velocity probably matters but the influence has not been extensively studied. There is a bit of evidence in the sports medicine literature to support the idea, but most of the evidence is simply a linking of an overall increase in the number of pitchers throwing at high velocities and the increase in injuries. The velocity story ties in with the increase in weight-training and similar similar to the thinking about knee injuries in football – players can increase muscle mass and force but this places greater stresses on key joints, like the knee or elbow, where only limited strengthening is possible.

3. Specific types of pitches, such as curveballs at young ages, may stress the arm more but finding solid evidence of their impact is elusive. This is one of the longstanding bits of conventional wisdom that’s been around since I was a kid. Some of the famous orthopedic surgeons think it holds true. Organizations like the Rays have refined it to limit the use of “cut fastballs” by their young minor league pitchers. There has been suspicion about other pitches including the “split-finger fastball.” The odd thing is, if it is such a truism, why doesn’t it show up in the data in an obvious way?

4. The success of the surgery entices more users. It’s the new steroid injection for pitchers. This influence doesn’t receive much press, and, no doubt, some medical professionals would bristle at the mere suggestion. However, there has been a (mis)perception that the surgery may actually increase performance. (The data suggests that return to old level is likely but not certain and hardly anyone experiences the problem again). Tommy John’s elbow ligament ruptured. He had no other options. Many of the pitcher undergoing the procedure now have not reached such a last-resort position. They are experiencing pain that in bygone eras might have been treated with rest and maybe an altered, less-stressful pitching style.

José Fernandez (Photo credit: Corn Farmer)

Why is it so difficult to pin down the answer? Back to the economics and recessions analogy. To start, there may not be a single, definitive answer. More than one of these factors may be contributing and there may be interaction between contributing factors. For all of its progress, medical science tends to rely heavily on relatively simple cause and effect that can be sorted out in a lab. This microbe causes this disease. Where multiple influences intermingle, such as with some neurological disorders (as I have experienced), the waters muddy in a hurry and laboratory tests are not as definitive or even possible. Out of necessity, observational studies dominate. With different data samples, time frames, and methods, the results are not always consistent and sometimes contradictory.

A related complication is the existence of a chain of participation levels. It isn’t just MLB. There is youth baseball, high school ball, college and minor league ball, and then the big leagues. Practices differ at each level coupled with obvious and subtle physiological development.

Like economic events, everyone has a seat-of-the-pants opinion ranging from youth baseball whether too many pitches or too many curveballs, to an over-emphasis on velocity, to training regimens, and beyond. Where entrenched views already exist, discussion gets side-tracked and evidence dismissed too easily or not even sought.

In the absence of definitive answers as to the influences, a couple of experiments might be worth trying. Japanese pitchers are not experiencing nearly as high of a rate of injury and surgery, even though pitch counts tend to be higher. Imitating some of their practices, limited weight lifting, might be useful. Whether with this or on its own, expanding the strike zone might induce more pitchers to scale back on power pitching.

Post Your Comment

Post Your Reply

Forbes writers have the ability to call out member comments they find particularly interesting. Called-out comments are highlighted across the Forbes network. You'll be notified if your comment is called out.